Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Kidney Donor Profile Index (KDPI) is calculated using 10 donor variables including terminal serum creatinine (Cr) and is used in the new kidney allocation system to define organ quality and organ allocation sequence. However, for a donor with acute kidney injury (AKI) requiring dialysis, the terminal Cr may represent the post dialysis Cr and hence is not reflective of donor's glomerular filtration rate.
We report two successful kidney transplants from a donor with severe anuric AKI requiring dialysis at the time of organ recovery. We utilized peak and post dialysis serum Cr to demonstrate the variability in KDPI.
The donor was 17 years old with admission Cr of 1mg/dl and developed anuric AKI with peak Cr of 4.86 mg/dl prior to dialysis initiation. At the time of organ procurement the post-dialysis Cr was 1.9 mg/dl and the reported KDPI was 21%. The kidneys were allocated to a 68 year old and a 69 year old recipient. Both recipients had diabetes mellitus and had been on dialysis for 7 years. None of the recipients had prior transplants. Both recipients had delayed graft function but achieved stable kidney function with Cr of 1.5 mg/dl at 3 months post-transplant. Under the new kidney allocation system the Estimated Post Transplant Survival (EPTS) score for these recipients is 97% and 98% respectively.
The KDPI in this donor would be 10% with Cr of 1.0 mg/dl (admission Cr) and 24% with Cr of 4.86 mg/dl (peak Cr prior to dialysis initiation). A terminal Cr of ≤ 1.8 mg/dl would result in KDPI of ≤ 20% and the kidneys would be offered to recipients in Sequence A (EPTS ≤ 20%) under the new allocation system. Terminal Cr between 1.9 mg/dl and 8 mg/dl (which is the capped creatinine limit for KDPI calculator) would result in KDPI of 21% to 28% and therefore the kidneys will be offered to sequence B (EPTS ≤ 35%).
Conclusion: Among donors with AKI requiring dialysis, the KDPI is spuriously low when terminal Cr is used. We propose that Cr of 8 mg/dl, which is the capped limit of Cr in the KPDI calculator could be utilized for KDPI estimation in dialysis dependent donors with AKI. Further studies are warranted to validate the proposed model.
To cite this abstract in AMA style:Pai A, Ghanta M, Rao S, Gillespie A, Karhadkar S, Lau K, Carlo ADi, Constantinescu S, Lee I. Kidney Donor Profile Index Variability in Donors With Dialysis Dependent Acute Kidney Injury and the Impact On Organ Allocation [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/kidney-donor-profile-index-variability-in-donors-with-dialysis-dependent-acute-kidney-injury-and-the-impact-on-organ-allocation/. Accessed April 20, 2021.
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